scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

How Often does Computed Tomography Change the Management of Acute Appendicitis?

2009 ◽  
Vol 75 (10) ◽  
pp. 918-921 ◽  
Author(s):  
David A. Santos ◽  
Jesse Manunga ◽  
Donald Hohman ◽  
Elisa Avik ◽  
Edward W. Taylor
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Operative Management ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Interval Appendectomy ◽  
Negative Appendectomy Rate

Computed tomography (CT) diagnoses appendicitis accurately, but few studies evaluate how often CT changes the management of appendicitis. Consultations for appendicitis were evaluated by surgeons and assigned to groups: high, indeterminate, and low suspicion. After assignment, CT was reviewed if completed or ordered if desired by the surgeon and changes in plans were noted. One hundred patients were evaluated for appendicitis, 70 received appendectomy. Our negative appendectomy rate was 4 of 70 (5.7%). In the high suspicion group, 63 patients had 23 CT scans performed and 2 CT scans were negative, avoiding unnecessary operation and changing management in 2 of 63 (3.2%). The intermediate suspicion group included 27 patients and 26 CT scans performed; 11 were positive resulting in nine positive appendectomies and changing management in 9 of 27 (33%). The low suspicion group had 7 CT scans performed; two were positive leading to two positive appendectomies and changing management in 2 of 10 (20%). CT promoted 10 of 100 patients to the interval appendectomy pathway with no failures in delayed operative management. CT rarely changes management in patients highly suspicious for appendicitis, but may have a role in selecting patients for interval appendectomy. CT frequently changes management if the clinical diagnosis is indeterminate.

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

Negative Appendectomy Rate: Influence of CT Scans

2005 ◽  
Vol 71 (10) ◽  
pp. 803-808 ◽  
Author(s):  
Marcial Mcgory ◽  
Davids Zingmond ◽  
Darshani Nanayakkara ◽  
Melinda A. Maggard ◽  
Clifford Y. Ko
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Patient Age ◽  
Entire Cohort ◽  
Patient Âgé ◽  
Negative Appendectomy Rate ◽  
The Impact ◽  
Age And Sex

Negative appendectomy rate varies significantly depending on patient age and sex. However, the impact of computed tomography (CT) scans on the diagnosis of appendicitis is unknown. The goal of this study was to examine the negative appendectomy rate using a statewide database and analyze the association of receipt of CT scan. Using the California Inpatient File, all patients undergoing appendectomy in 1999–2000 were identified (n = 75,452). Demographic and clinical data were analyzed, including procedure approach (open vs laparoscopic) and appendicitis type (negative, simple, abscess, peritonitis). Patients with CT scans performed were identified to compare the negative appendectomy rate. For the entire cohort, appendicitis type was 59 per cent simple, 10 per cent with abscess, 18.7 per cent with peritonitis, and 9.3 per cent negative. Males had a lower rate of negative appendicitis than females (6.0% vs 13.4%, P < 0.0001). The use of CT scans was associated with an overall lower negative appendectomy rate for females, especially in the <5 years and >45 years age categories. Use of CT scans in males does not appear to be efficacious, as the negative appendectomy rates were similar across all age categories. In conclusion, use of CT was associated with lower rate of negative appendectomy, depending on patient age and sex.

Accuracies of Diagnostic Methods for Acute Appendicitis

2013 ◽  
Vol 79 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Jong Seob Park ◽  
Jin Ho Jeong ◽  
Jong In Lee ◽  
Jong Hoon Lee ◽  
Jea Kun Park ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Physical Examination ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Negative Appendectomy ◽  
Pathologic Findings ◽  
Negative Appendectomy Rate ◽  
Sensitivity Specificity

The objectives were to evaluate the effectiveness of ultrasonography, computed tomography, and physical examination for diagnosing acute appendicitis with analyzing their accuracies and negative appendectomy rates in a clinical rather than research setting. A total of 2763 subjects were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value and negative appendectomy rate for ultrasonography, computed tomography, and physical examination were calculated. Confirmed positive acute appendicitis was defined based on pathologic findings, and confirmed negative acute appendicitis was defined by pathologic findings as well as on clinical follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 99.1, 91.7, 96.5, and 97.7 per cent, respectively; for computed tomography, 96.4, 95.4, 95.6, and 96.3 per cent, respectively; and for physical examination, 99.0, 76.1, 88.1, and 97.6 per cent, respectively. The negative appendectomy rate was 5.8 per cent (5.2% in the ultrasonography group, 4.3% in the computed tomography group, and 12.2% in the physical examination group). Ultrasonography/computed tomography should be performed routinely for diagnosis of acute appendicitis. However, in view of its advantages, ultrasonography should be performed first. Also, if the result of a physical examination is negative, imaging studies after physical examination can be unnecessary.

Abdominal Computed Tomography in the Evaluation of Acute and Perforated Appendicitis in the Community Setting

2007 ◽  
Vol 73 (10) ◽  
pp. 1002-1005 ◽  
Author(s):  
D.O. Vu Huynh ◽  
Fariborz Lalezarzadeh ◽  
Shokry Lawandy ◽  
David T. Wong ◽  
Victor C. Joe
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Predictive Value ◽  
Perforated Appendicitis ◽  
Community Setting ◽  
Diagnostic Value ◽  
Academic Community ◽  
Negative Appendectomy ◽  
Community Based ◽  
Abdominal Computed Tomography

Several studies report sensitivity and specificity of abdominal computed tomography scans (CT) for the evaluation of acute appendicitis as high as 98 per cent. Despite increased utilization of CT, the rate of negative appendectomy has remained constant at 10 to 20 per cent. The objective of this study was to assess the effectiveness of CT in the evaluation of acute and perforated appendicitis in an academic community-based setting. A retrospective review of 550 patient charts with International Classification of Diseases-9 (ICD-9) codes for acute and perforated appendicitis from January 2002 to October 2005 was performed. Sensitivity of CT was 87 per cent with a positive predictive value of 92 per cent. Specificity was 42 per cent with a negative predictive value of 29 per cent. Negative appendectomy rates were similar with or without CT (11% vs 13%, respectively). Our data suggests that CT used liberally in everyday practice in a community-based setting to evaluate acute appendicitis may not have as strong of a diagnostic value as those used in protocol-driven research studies. Further prospective studies are needed to formulate criteria to better delineate the role of CT in the evaluation of acute appendicitis.

scholarly journals EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fady Hatem ◽  
Samir Mostafa ◽  
Basel Chamali ◽  
Andrea Ivanov ◽  
Rebecca Ross ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Published Data ◽  
Negative Appendectomy ◽  
Child Bearing ◽  
Single Centre Study ◽  
Positive Scan ◽  
Negative Appendectomy Rate ◽  
The Mean ◽  
Low Sensitivity ◽  
The Uk

Abstract Aims Appendicitis remains the most common acute surgical condition.  No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis.  Methods A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done. Results 632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan.  Conclusions Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis.  However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.

scholarly journals A study to find out correlation between clinical diagnosis and histopathological diagnosis in patients with acute appendicitis undergoing surgical treatment

2019 ◽  
Vol 6 (6) ◽  
pp. 2046
Author(s):  
Mohit Jain ◽  
Yogesh Kumar Sharma
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Scoring System ◽  
Emergency Operation ◽  
Negative Appendectomy ◽  
Histopathological Diagnosis ◽  
Complication Rates ◽  
Diagnostic Modality ◽  
Negative Appendectomy Rate ◽  
A Prospective Study

Background: Acute appendicitis is one of the most frequent abdominal emergencies and appendectomy subsequently the most common emergency operation performed all over the world. The aim of the study is to evaluate the reliability of Clinical Diagnosis for diagnosis of acute appendicitis and correlate it with the gold standard and absolute diagnostic modality, histopathology.Methods: This is a prospective study carried out in 150 patients who were admitted under department of surgery, AFMC Pune, Maharashtra from 1st July 2014 to 31st June 2016 for a clinical diagnosis of acute appendicitis.Results: In our study overall negative appendectomy rate was 18.7% (12.37% in male and 30.19% in female). Hence in the overall females had more negative appendectomy rate compared to males. In our series a score of >7 using Alvarado system had a total sensitivity of 72.95%. While sensitivity increases to 99.18% when score of >5 used as cut-off.Conclusions:Alvarado scoring system is beneficial in decreasing negative appendectomy rate and thus reduces complication rates. It is effective in the diagnosis of acute appendicitis in both men and females but some other diagnostic modality may be necessary to ascertain the diagnosis in females along with the clinical scoring system to rule out other pelvic pathology and to reduce negative appendectomy rate in females. 

scholarly journals Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

2021 ◽  
Vol 18 (2) ◽  
pp. 109-114
Author(s):  
Masawa Klint Nyamuryekung’E ◽  
Ali Athar ◽  
Miten Ramesh Patel ◽  
Aidan Njau ◽  
Omar Sherman ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Associated Factors ◽  
Lifetime Risk ◽  
Histological Evaluation ◽  
Negative Appendectomy ◽  
Perforation Rate ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Referral Hospitals ◽  
Negative Appendectomy Rate

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for  suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis. Keywords: Negative appendectomy rate, SubSaharan Africa, Alvarado score, Appendectomy, Suspected acute appendicitis

scholarly journals Roles of Clinical Criteria, Computed Tomography Scan, and Adrenal Vein Sampling in Differential Diagnosis of Primary Aldosteronism Subtypes

2008 ◽  
Vol 93 (4) ◽  
pp. 1366-1371 ◽  
Author(s):  
Paolo Mulatero ◽  
Chiara Bertello ◽  
Denis Rossato ◽  
Giulio Mengozzi ◽  
Alberto Milan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Sensitivity And Specificity ◽  
Primary Aldosteronism ◽  
Final Diagnosis ◽  
Ct Scans ◽  
Lower Sensitivity ◽  
Clinical Criteria ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Posture Test

Abstract Context: In patients with primary aldosteronism (PA), it is fundamental to distinguish between subtypes that benefit from different therapies. Computed tomography (CT) scans lack sensitivity and specificity and must be followed by adrenal venous sampling (AVS). Because AVS is not widely available, a list of clinical criteria that indicate the presence of an aldosterone-producing adenoma (APA) has been suggested. Objective and Design: The objective of the study was to test the sensitivity and specificity of the last generation CT scans, test prospectively the usefulness of clinical criteria in the diagnosis of APA, and develop a flow chart to be used when AVS is not easily available. Setting: Hypertensive patients referred to our hypertension unit were included in our study. Patients: Seventy-one patients with confirmed PA participated in our study. Intervention: All patients had a CT scan and underwent AVS. Main Outcome Measure: Final diagnosis of APA was the main measure. Results: A total of 44 and 56% of patients were diagnosed as having an APA and a bilateral adrenal hyperplasia (BAH), respectively. Twenty percent of patients with PA displayed hypokalemia. CT scans displayed a sensitivity of 0.87 and a specificity of 0.71. The posture test displayed a lower sensitivity and specificity (0.64 and 0.70, respectively). The distribution grades of hypertension were not significantly different between APA and BAH. Biochemical criteria of high probability of APA displayed a sensitivity of 0.32 and a specificity of 0.95. Conclusions: This study underlines the central role of AVS in the subtype diagnosis of PA. The use of the clinical criteria to distinguish between APA and BAH did not display a satisfactory diagnostic power.

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